Do’s and Don’ts Of Medicare Compliance

Before you can begin selling Medicare, you must first get your license to sell Medicare products, followed by certifications from carriers to sell Medicare Supplement Plans. But after all that, there is still one more thing to be aware of before you’re ready to sell. You need to know how to remain compliant with all the rules surrounding Medicare sales. In order to show your commitment to honesty and integrity, as well as to fulfill your legal duty and contractual obligations to sell Medicare, you have to be compliant with the following rules in all of your interactions with customers. Here are some simple do’s and don’ts to help you stay in compliance.

Medicare Compliance For Selling

When Selling Medicare:

DO:

caucasian man with a white button up sitting down filling out a form
Before contacting a lead, make sure to fill out a Scope of Appointment.
  • Make sure that you have Permission To Contact the prospect. Agents are not allowed to make unsolicited phone calls or send emails to prospects without having an opt-out option. In order to obtain permission to contact, you must use a lead provider like Benepath, who will have prospects/leads sign a form that says they agree to be contacted by an agent.
  • Complete a Scope Of Appointment form before each face-to-face appointment and/or one-on-one phone conversation. These forms outline exactly what you’ll be talking about with your client during a meeting. Per CMS, you must keep these forms on file for at least 10 years, even if your conversation did not end in a sale.
  • Report any suspected violations to the Medicare Compliance Hotline toll-free at 1-877-211-2290.

DON’T:

  • Engage in door-to-door marketing or sales
  • Use high pressure sales tactics
  • Engage in outbound telemarketing or email campaigns
  • Discuss with prospects any products that are not specified in their Scope of Appointment form
  • Engage in any discriminatory activities, such as conditional enrollment based on a prospect’s mental illness, physical illness, or disability

Medicare Compliance For Marketing

CMS also has regulations in place for marketing, educational events and sales event presentations.

DO:

illustration of a man in a suit talking to a group of people sitting down.
When marketing, you can distribute educational materials at an event that are not plan-specific as well as your business cards.
  • Wait until October 1 to begin marketing next year’s plans to potential customers
  • Distribute educational materials that are free of plan-specific information
  • Give out your business card and contact info
  • Collect Scope of Appointment forms
  • Hold your event in a public venue

DON’T:

  • Attempt to mislead your clients, willingly or unwillingly
  • Use the word free to describe $0 premiums
  • Serve meals at sales events
  • Pressure attendees at events to complete a sign in, it must be optional
  • Distribute plan-specific materials at an educational event (only do this at sales events)
  • Discuss any carrier-specific plans or benefits at educational events (only do this at sales events)
  • Cross-sell or promote health-related products at events

It is important that you follow these rules for Medicare compliance set by CMS, or you risk violations, and you may lose your ability to sell Medicare if you are reported. If you are looking for leads that have given permission to contact, Benepath will provide these leads exclusively to you. We give you exclusive real-time leads when you want them. To find out more information, call 866-368-0377.

What Does “Ready To Sell” Mean?

When it comes to selling Medicare Supplement Plans, you don’t have to limit yourself to the Open Enrollment Period! There are over 11,000 Baby Boomers turning 65 every day, which means not only opportunities to make a lot of sales, but also to earn a residual income. Selling Medicare Supplement Plans is a lucrative business that you can make a good living from, but before you begin selling, you must be “ready to sell.” Just because you are contracted with an insurance carrier does not necessarily mean that you’re “ready to sell.” There are certain steps that you have to take first.

computer mouse over the word license
Check your local state requirements to get licensed.

1. Get a Medicare License To Sell

Before completing any of the following certifications, you have to be properly licensed to sell Medicare products per your state’s Department of Insurance requirements. You must pass a state licensing exam and then apply for your license. Make sure to check with your state’s Department of Insurance for licensing requirements for your specific state.

2. Complete AHIP Certifications

America’s Health Insurance Plans, or AHIP, represents over 1,000 companies that offer insurance. In order to sell Medicare products, you will be required to complete AHIP training. The training is designed to educate agents on selling Medicare plans as well as on protecting seniors. When you receive this training, you will learn the basics of:

  • Medicare fee-for-service eligibility and benefits
  • Eligibility and coverage
  • The different types of Medicare plans
  • Compliance with marketing guidelines and enrollment procedures
  • How to detect and report fraud, waste, and abuse

Once you have received this training and are familiar with CMS regulations and guidelines, you will satisfy the requirement of insurers to sell their plans.

2. Complete Carrier Specific Certifications

illustration of a man in a suit motioning towards a certificate

Once you have completed the AHIP certification, the next step is to get certified with the insurance carriers you are going to work for. Some of the large carriers, such as Aetna and Humana, require individual product certifications in order to be able to sell their plans. You will be given three opportunities to pass their product certification test; if you fail all three times, then you will be unable to sell their products for one full year.

3. Finding Valuable Leads

Once you have completely passed all the certifications required, then the final step is to find valuable leads so you can start selling! The best way to do this is to work with Benepath, because we offer real-time, exclusive leads. Customers come to our site, they fill out our form indicating that they are interested in purchasing a Medicare Supplement Plan, and then the lead is immediately sent to you in real time. You will receive a live transfer call, as well as a text and an email; they will even be linked to your CRM.

What sets Benepath apart from other companies is that our exclusive leads always expect your call. We provide a custom thank you page for each one of our agents: each prospect will see your information including your picture, your logo, and a brief description of you or your agency. We provide you with better tools, more guidance, and the best leads available thanks to our constant researching and technological advancement.

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